For a time I thought to blame my shoes....that possibly the sole (in particular the heel area) of the left shoe was going soft as the issue grew a little at a time over a couple of years. New shoes ruled that out.

I've not had any issues with my ankles and no knee pain associated with this situation....just that bothersome left heel kicking out....and I forgot to mention earlier it also led to my left knee coming closer to the top tube and on a few occasions would brush against it. With the fixed cleats (carefully adjusted) my feet-ankle-knees all track nicely, no issues with joint pain, and as noted earlier I feel a better connection to the bike.

If the heel is pointing out that means the cleat is too far in which means the Q-factor if anything is too small, not large, correct?

I'm not sure what you mean by "all the way in on pedals"... cleat inbound (larger Q) or outbound (smaller Q).

If I run cleats too far out (small Q) I get knee pain.

_________________
http://djconnel.blogspot.com/
Fuji SL/1
Send your data to Weight Weenie listings!

Two likely explanations:
1) your saddle is too high and your displaying right side bias... Ie favoring your dominant leg by shifting to the right to shorten the R stroke, and lengthening the L (hence left knee pain)

To fix lower your saddle 2mm at a time and see if this squares you up on your saddle

OR

2) you have a shorter right leg, therefore shimming will fix...

Therefore get someone experienced to measure both legs and compare, and shim appropriately...

Some articles well worth reading to help fix your fit issues are:

http://www.stevehoggbikefitting.com/blo ... side-bias/

http://www.stevehoggbikefitting.com/blo ... -shimming/

http://www.stevehoggbikefitting.com/blo ... of-a-shim/